Provider Demographics
NPI:1104820679
Name:BIOSCRIP PHARAMCY INC
Entity type:Organization
Organization Name:BIOSCRIP PHARAMCY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MELANCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-449-6939
Mailing Address - Street 1:10050 CROSSTOWN CIR
Mailing Address - Street 2:STE 300
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3348
Mailing Address - Country:US
Mailing Address - Phone:800-753-5995
Mailing Address - Fax:952-352-6698
Practice Address - Street 1:21 STANHOPE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5111
Practice Address - Country:US
Practice Address - Phone:617-375-7969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-11
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MA29443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010392Medicaid
NH30702329Medicaid
MA0448133Medicaid
ME414360000Medicaid
NY02732763Medicaid
CT003128718Medicaid
CT003128718Medicaid